Psych - FA p542 - 559 Flashcards
After burning his fingers 3x by touching the candle, little Joe learned never to touch fire again. What type of conditioning is that?
Punishment
Child finishes up his “yucky” veggis to be able to get ice-cream after. What type of conditioning is that?
Positive reinforcement
T or F? Classical conditioning is a permissive response.
F. it is involuntary
Operant conditioning is the opposite of —.
Classical conditioning
Guantanamo prisoner pleaded guilty after being Waterboarded for 2 hours. What type of conditioning is that?
Negative reinforcement “use of neg force”
— can occur in operant or classical conditioning.
Extinction (you can cut the link btw stimulus and behavior)
First yr resident yells at a med student, because her attending physician yelled at her earlier about her bedside manners.
Displacement
Fixation can be mistaken for —. compare them.
regression–>Turning back the maturational clock. Seen in children under stress such as illness, punishment, or birth of a new sibling Fixation–>Partially remaining at a more childish level of development. Adult playing video games.
— is when patient reminds physician of younger sibling.
Countertransference
A child wears his hat backwards bc he sees his favorite actor do it on television
Identification –> Modeling behavior after another person who is more powerful (though not necessarily admired).
Temporary, drastic change in motor behavior to avoid emotional stress is called?
Dissociation
Student who hates geography is repeatedly late for class and performs below average on tests.
Passive Aggression
A student who wants to cheat on an exam thinks his classmates are doing the same.
Projection
Physician describing in graphic detail with no emotional response the death of murdered pt. Is the physician’s behavior a mature or immature defense mechanism?
Isolation, Immature
An alcoholic pt becomes the speaker of the AA group.
Reaction Formation
T or F? Repression is voluntarily withholding an idea or feeling from conscious awareness.
F. Involuntary
Husband’s aggression toward his wife is redirected to perform well at his job. Mature or immature defense mech?
Sublimation;mature
A physician chooses to not worry about having acquired HIV from a needle prick until the actual test results are positive.
Suppression
Long term deprivation of affection in infants result in
- failure to thrive,
- poor language/social skills
- lack of basic trust,
- reactive attachment disorder (infant withdrawn & unresponsive to comfort)
- Disinhibited social engagement (child indiscriminately attaches to strangers)
what is the time frame for irreversible changes in deprivation in an infant
> 6months and severe deprivation can lead to infant death
in child abuse who is the abuser in physical abuse and who is the abuser in sexual abuse, most often
biological mother (physical) Known to victim, usual male (sexual)
what is the most common form of child maltreatment
Child neglect
when a parent perceives a child as susceptible to illness and injury, which can result to missed school or overuse of medical services - what is this called?
Vulnerable child syndrome
limited attention span, normal intelligence and poor impulse control refers to
attention deficit hyperactivity disorder
treatment for attention deficit hyperactivity disorder
methylphenidate, cognitive behavior therapy, atomoxetine, guanfacine, clonidine
what disorder is associated with increase head/brain size and common in boys
Autism
what is the Mode of inheritance for Rett syndrome and what gender is affected most
X linked dominant & girls
stereotyped hand-wringing is associated with ———
Rett syndrome
repetitive behavior violating the basic rights of others or social norms and destruction of property is associated with
conduct disorder/antisocial disorder
Treatment of conduct and antisocial disorder
Psychotherapy such as CBT
Enduring pattern of hostile, defiant behavior toward authority gures in the absence of serious violations of social norms refers to
Oppositional defiant disorder
Overwhelming fear of separation from home or loss of attachment figure refers to
Separation anxiety disorder
normal behavior up age 3-4
17 year old male Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year is what path
Tourette syndrome (onset before 18yrs)
what are the association and Tx for Tourette syndrome
Associated with OCD and ADHD. TX psychoeducation, behavioral therapy. For intractable tics, low-dose high-potency antipsychotics (e.g., fluphenazine, pimozide), tetrabenazine, and clonidine may be used.
what are the neurotransmitter changes in Alzheimer disease
dec ACh inc glutamate
what are the neurotransmitter changes in anxiety
inc NE, Dec Gaba, 5-HT
neurotransmitter changes in Huntington disease
dec Gaba, ach inc dopamine
what are the neurotransmitter changes in schizophrenia
Inc Dopamine
Causes of Loss of Orientation
alcohol, drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, infection, nutritional deficiencies, hypoxia
list the order of orientation loss
Order of loss: 1st—time; 2nd—place; last— person.
Inability to remember things that occurred before a CNS insult.
Retrograde amnesia
Inability to remember things that occurred after a CNS insult ( dec acquisition of new memory)
Anterograde amnesia
Amnesia (anterograde > retrograde) caused by vitamin B1 de ciency and associated destruction of mammillary bodies. Seen in alcoholics. Confabulations are characteristic.
Korsakoff syndrome
what is Dissociative amnesia
Inability to recall important personal information, usually subsequent to severe trauma or stress. May be accompanied by dissociative fugue (abrupt travel or wandering during a period of dissociative amnesia, associated with traumatic circumstances).
Characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep- wake cycle, cognitive dysfunction.
Delirium
————is characterized by irreversible memory loss.
Dementia
what type of hallucination occurs while going to sleep. Sometimes seen in narcolepsy.
Hypnagogic
Occurs while waking from sleep and sometimes seen in narcolepsy
Hypnapompic
what type of hallucination is associated with the sensation of bugs crawling on one’s skin; where is it seen?
tactile seen in alcoholic withdrawer and cocaine abuse
hallucination & delusion longer than 6 months is seen in
Schizophrenia
what are the positive symptoms of schizophrenia (4)
- hallucinations,
- delusions,
- unusual thought processes,
- disorganized speech,
- bizarre behavior
what are the negative symptoms of schizophrenia
- flat or blunted affect,
- apathy,
- anhedonia,
- alogia,
- social withdrawal
hallucination lasting less than 1month
Brief psychotic disorder
hallucination lasting 1-6 months
schizophreniform
lasting > 2 weeks; psychotic symptoms with episodic superimposed major depression or mania (or both). Psychosis is present with and without mood disorder, but mood disorder is present only with psychosis refers to
Schizoaffective disorder
long term deprivation of affection in infants result in
Failure to thrive Poor language/socialization skills Lack of basic trust Reactive attachment disorder (infant withdrawn/unresponsive to comfort) Disinhibited social engagement (child indiscriminately attaches to strangers)
a woman who genuinely believes she is married to a celebrity when, in fact, she is not is what disorder?
Delusional disorder
Daily functioning, including socialization, may be impacted by the pathological, fixed belief but is otherwise unaffected. Can be shared by individuals in close relationships (folie à deux).
list 6 things that associates with Dissociative identity disorder
history of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatoform conditions.
what disorder is associated with persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions
Depersonalization/ derealization disorder
DIGFAST which is used for diagnosis and hospitalization in manic episode stands for?
Distractibility
Impulsivity/Indiscretion—seeks pleasure without regard to consequences (hedonistic)
Grandiosity—inflated self-esteem
Flight of ideas—racing thoughts
goal-directed Activity/psychomotor Agitation
dec need for Sleep
Talkativeness or pressured speech
what is hypomanic episode
Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features. Lasts at least 4 consecutive days.
what is the time frame for irreversible changes in deprivation in an infant
> 6months and severe deprivation can lead to infant death
of Days to qualify as hypomanic episode?
Last at least 4 consecutive days
What makes a hypomanic episode diff from a manic episode?
Similar to a manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features.
Diff between Bipolar I and II
Bipolar I defined by presence of at least 1 manic episode +/− a hypomanic or depressive episode. Bipolar II defined by presence of a hypomanic and a depressive episode.
Drugs that can ppt mania?
Use of antidepressants can destabilize mood.
Tx for Bipolar disorder?
Treatment: mood stabilizers (eg, lithium, valproic acid, carbamazepine), atypical antipsychotics.
Minimal duration of cyclothymic disorder?
Must last ≥ 2 years with symptoms present at least half of the time, with any remission lasting ≤ 2 months
How long do major depressive episodes last?
Episodes characterized by ≥ 5 of the 9 diagnostic symptoms lasting ≥ 2 week
What symptoms are included to Dx Major Depressive disorders?
SIG E CAPS: Depressed mood Sleep disturbance Loss of Interest (anhedonia) Guilt or feelings of worthlessness Energy loss and fatigue Concentration problems Appetite/weight changes Psychomotor retardation or agitation Suicidal ideations
__#__ Sx out of __#__ ttl Sx for ____ (length of time) for diagnose Major Depressive Disorder?
Episodes characterized by at least 5 of the following 9 symptoms for 2 or more weeks
1st line Tx for Major Depressive Disorder?
CBT and SSRIs
2nd line Tx for Major Depressive Disorder?
SNRIs, mirtazapine, bupropion can also be considered.
Persistent depressive disorder
depression, often milder, lasting at least 2 years.
Changes in sleep in patients with Depression?
slow-wave sleep REM latency REM early in sleep cycle total REM sleep Repeated nighttime awakenings Early-morning wakening (terminal insomnia)
What makes depression atypical?
Characterized by mood reactivity (predominantly depression, but patients have the ability to experience transient mood improvement in response to positive events),
- hypersomnia,
- hyperphagia,
- leaden paralysis (heavy feeling in arms and legs),
- long-standing interpersonal rejection sensitivity
Sx of postpartum psychosis?
Characterized by mood-congruent delusions, hallucinations, and thoughts of harming the baby or self.
Most common method to commit suicide? Are men or women more likely to commit suicide?
Most common method in US is firearms, Women attempt suicide more often, men tend to succeed with it.
Symptoms of Panic attack?
PANICS
Palpitations, Paresthesias, dePersonalization or derealization, Abdominal distress or Nausea, Intense fear of dying, Intense fear of losing control or “going crazy,” lIght-headedness, Chest pain, Chills, Choking, Sweating, Shaking, Shortness of breath (“P3AN[ICS]3”).
How to treat a specific phobia?
Can be treated with systematic desensitization. ** NOTE - Patient does recognize that fear is excessive
Define Gen anxiety disorder
Excessive anxiety and worry about different aspects of daily life (eg, work, school, children) for most days of ≥ 6 month
How is adjustment disorder different from Gen anxiety disorder?
If symptoms persist > 6 months after stressor ends, it is GAD
How is OCD different from OC personality disorder?
Ego-dystonic: behavior inconsistent with one’s own beliefs and attitudes vs the personality disorder where the it is consistent
Acute stress disorder v Post traumatic stress disorder?
Acute - lasts between 3 days and 1 month. PTSD - lasts longer >1 mo
Malingering
Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to **attain a specific 2° (external) gain** (eg, avoiding work, obtaining compensation). Poor compliance with treatment or follow-up of diagnostic tests.
Difference between factitious disorder and malingering?
Complaints in malingering cease after gain obtained (vs factitious disorder).
Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention
Factitious disorder
Difference between malingering and somatic symptoms?
Malingering may be unconcious, but it is fabricated or exagerrated symptoms. Somatic illness and motivation are entirely unconscious, but not intentionally produced or feigned
Loss of sensory or motor function (eg, paralysis, blindness, mutism), often following an acute stressor; patient is aware of but sometimes indifferent toward symptoms
Conversion disorder
Excessive preoccupation with acquiring or having a serious illness, often despite medical evaluation and reassurance;
Illness anxiety disorder
False, nondelusional belief of being pregnant. May have signs and symptoms of pregnancy but is not pregnant.
Pseudocyesis
Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning, person is usually not aware of problem (ego-syntonic)
Personality disorder
Difference between Schizoid vs Schizotypal?
SchizOiD - alOne and Distant - likes to be alone and is fine with it. Schizotypal - look for eccentric appearence or odd/magical thinking.
Which B cluster personality disorder is associated with males?
Antisocial
What differentiates antisocial personality disorder from conduct disorder?
Age - Antisocial personality disorder must be ≥ 18 years old and have history of conduct disorder before age 15. Diagnosis is conduct disorder if < 18 years old.
Which cluster B disorder is associated with females?
Borderline
self-mutilation, suicidality, sense of emptiness; females > males
Borderline
Most common defense mech of borderline? and define it
Splitting
sexually provocative, overly concerned with appearance.
Histrionic
Grandiosity, sense of entitlement; lacks empathy and requires excessive admiration; often demands the “best” and reacts to criticism with rage
Narcissistic
Difference between avoidant and shizoid?
Avoidant desires relationships with others but is alone, Schizoid perfectly happy with being alone
People of this personality type tend to get involved in abusive relationships?
Dependent - Submissive and clingy, excessive need to be taken care of, low self-confidence
what is the refeeding syndrome?
When reintroducing food to an anorexic, the inc in insulin –> hypophosphatemia, hypokalemia, hypomagnesemia –> cardiac complications, rhabdomyolysis, seizures.
what type of stress fractures you see in anorexia nervosa?
Metatarsal stress fracture
which eating disorder is the one with normal body weight
bulimia nervosa
what is Russell sign
dorsal hand calluses from induced vomiting
Narcolepsy is associated with a decrease in what? where is it produced?
Caused by dec in Hypocretin (orexin); produced in lat HT
Night time treatment of narcolepsy
Sodium oxybate
what is varenicline and where is it used?
for nicotine withdrawal its a partial agonist of nicotinic AchR
Pick out the drugs (when intoxicated) that can cause mydriasis 1. Alcohol 2. Opioids 3. Barbs and BDZ 4. Amphetamine 5. Cocaine 6. PCP 7. LSD 8. Marijuana
Amphetamine and Cocaine, Marijuana
treatment of cocaine intox, and what would you have to avoid?
benzodiazepines; consider mixed α-/β-blocker (eg, labetalol) for hypertension and tachycardia
No pure BB
What drug do you go “cold turkey” with? What does that mean?
Opiod withdrawal, piloerection of skin
Opiods Tx for intoxication and withdrawal
intox: naloxone, naltrexone withdrawal: methadone, buprenorphine
which opioid antagonist is not orally available so withdrawal symptoms occur only if IV, so lower abuse potential
Nalaxone
why do you use clonidine for opioid withdrawal?
alpha2 agonist
List 3 symptoms of PCP intoxication
- Aggression (Belligerence) 2. Vertical + horizontal nystagmus 3. Acute brain syndrome (disorient, poor judgement, memory loss)
College student at rave party comes in with symptoms of pyschosis. He said he sometimes find himself escaping from his body even though he is aware of everything around him. he is seeing color halos. what does he take?
LSD
Patient with AIDS, complain of vomiting and decreased appetite. After given a certain drug, he comes back with dry mouth, impaired time perception and conjunctival injection. what is the name of the drug
Cannabinoids
They are doing a urine test at your work, and you got high 2 weeks before. are you screwed?
yes MJ can be detected in urine up to 1 month
Heroin relapsed prevention once you are clean
Naltrexone PO
detox and maintenance of heroin
methadone full agonist! long acting
triad of Wernicke encephalopathy
confusion, ophthalmoplegia, ataxia
alcoholic withdrawal hallucinations: visual or auditory and how many hours after
visual 12-48 hrs after
